目的:探讨Riolan’s弓在血管外科慢性肠系膜上动脉(SMA)缺血性疾病中的治疗选择及临床预后价值。
方法:血管外科收治的215例SMA缺血性疾病患者(41例有Riolan’s弓,174例无)的临床资料,鼓楼附属医院,南京大学医学院(中国)于2019年1月至2023年4月进行了回顾。临床特征,影像学发现,治疗,围手术期并发症,并对患者随访资料进行分析,观察Riolan’s弓对SMA缺血性疾病患者预后的影响。
结果:体重指数存在显着差异(Riolan弓组:22.82±3.28vs非Riolan弓组24.03±4.26,P=0.049),大动脉炎(分别为4.9%和0,P=0.036),和二级干预(3.3%对1.9%,分别,两组之间P<0.001)。倾向评分匹配用于排除基线数据对患者预后的影响。治疗方法有显著差异(保守治疗,Riolan弓组:24.1%vs非Riolan弓组39.7%;手术治疗,Riolan足弓组:非Riolan足弓组的51.7%和20.7%,P=0.014),以及住院时间(分别为9.79±4.20和6.86±4.32,P=0.011)。两组Kaplan-Meier曲线比较差异无统计学意义(对数秩检验P=0.476)。
结论:Riolan足弓在SMA缺血性疾病中起着重要的代偿作用,尤其是慢性疾病。我们发现Riolan足弓的治疗方法和住院时间有显著差异,这可能表明Riolan的牙弓在治疗模式的选择上具有一定的参考价值。
OBJECTIVE: To explore the value of treatment choice and clinical prognosis for Riolan\'s arch in chronic superior mesenteric artery (SMA) ischaemic disease in vascular surgery.
METHODS: The clinical data of 215 patients with SMA ischaemic disease (41 cases with Riolan\'s arch and 174 cases without) admitted to the Department of Vascular Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University (China) from January 2019 to April 2023 were reviewed. Clinical characteristics, imaging findings, treatment, perioperative complications, and patient follow-up data were analysed to observe the impact of Riolan\'s arch on the prognosis of patients with SMA ischaemic disease.
RESULTS: There were significant differences in body mass index (Riolan\'s arch group: 22.82 ± 3.28 vs 24.03 ± 4.26 in non-Riolan\'s arch group, P = 0.049), Takayasu\'s arteritis (4.9% vs 0, respectively, P = 0.036), and secondary intervention (3.3% vs 1.9%, respectively, P < 0.001) between the two groups. Propensity score matching was used to exclude the effect of baseline data on patient outcomes. There were significant differences related to therapy method (conservative treatment, Riolan\'s arch group: 24.1% vs 39.7% in the non-Riolan\'s arch group; operative treatment, Riolan\'s arch group: 51.7% vs 20.7% in the non-Riolan\'s arch group, P = 0.014), as well as in-hospital time (9.79 ± 4.20 vs 6.86 ± 4.32, respectively, P = 0.011). There was no statistically significant difference in Kaplan-Meier curves between the two groups (log-rank test P = 0.476).
CONCLUSIONS: Riolan\'s arch plays an important compensatory role in SMA ischaemic disease, especially in chronic disease. We found significant differences in the treatment methods and length of hospital stay of Riolan\'s arch, which may suggest that Riolan\'s arch has some reference value in the choice of treatment mode.